1538264148 NPI number — RESURRECTION HEALTH CARE PREFERRED

Table of content: (NPI 1538264148)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538264148 NPI number — RESURRECTION HEALTH CARE PREFERRED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESURRECTION HEALTH CARE PREFERRED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538264148
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
355 RIDGE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60202-3328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-316-4719
Provider Business Mailing Address Fax Number:
847-316-6346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7345 W TALCOTT AVE
Provider Second Line Business Practice Location Address:
FINANCE DEPARTMENT
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60631-3706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-792-5115
Provider Business Practice Location Address Fax Number:
773-549-8567
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KANARY
Authorized Official First Name:
LENORE
Authorized Official Middle Name:
RUTH
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
847-316-4719

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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